Muresan Eugenia-Maria, Golea Adela, Vesa Stefan Cristian, Givan Iulia, Perju-Dumbrava Lacramioara
Department 10 - Neurosciences, Faculty of Medicine, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department 7 - Surgery, Emergency Medicine Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
In Vivo. 2022 May-Jun;36(3):1534-1543. doi: 10.21873/invivo.12864.
BACKGROUND/AIM: Spontaneous intracerebral hemorrhage (sICH) has a significant morbidity and mortality, despite representing a non-dominant hemorrhagic stroke. The aim of the study was to assess the impact of the emergency department (ED) point-of-care (POC) biomarkers on early mortality in sICH patients.
Demographic data, medical history and admission clinical parameters from adult patients with imaging-based sICH diagnosis were collected retrospectively, upon their ED presentation over a period of 18 months. ED-based POC analyzers were used for blood biomarkers [complete blood count, C reactive protein (CRP), glycemia, hepatic and renal function, D-dimer and cardiac troponin I]. Derived inflammatory indexes were calculated. Mortality endpoints were collected (on day 7 and at discharge).
Of the 219 included patients, mortality rates reached 30.14% on day 7 and 46.12% at discharge. In the univariate analysis, day 7 mortality was significantly associated with history of diabetes, atrial fibrillation, ongoing anticoagulant treatment, the need of endotracheal intubation and ED cardiopulmonary resuscitation, and the presence of intraventricular hemorrhage and mass effect on the initial CT scan. White blood cells and granulocytes (but not the neutrophil-to-lymphocytes ratio, nor the CRP) were significantly higher in the deceased groups, alongside serum glucose. Derived inflammatory indexes were not significantly correlated with mortality endpoints. Cut-off values of 9.6×10/l for granulocytes and 132 mg/dl for glucose were identified as day 7 mortality predictors.
sICH is a potentially severe condition causing high early mortality. Emergency department point-of-care biomarkers could represent a readily available and simple to use prognostic tool.
背景/目的：自发性脑出血（sICH）虽然是一种非主要的出血性卒中，但其发病率和死亡率都很高。本研究的目的是评估急诊科（ED）即时检测（POC）生物标志物对sICH患者早期死亡率的影响。
回顾性收集基于影像学诊断为sICH的成年患者在18个月期间于急诊科就诊时的人口统计学数据、病史及入院临床参数。使用基于急诊科的POC分析仪检测血液生物标志物[全血细胞计数、C反应蛋白（CRP）、血糖、肝肾功能、D-二聚体和心肌肌钙蛋白I]。计算得出炎症指标。收集死亡率终点数据（第7天和出院时）。
在纳入的219例患者中，第7天死亡率达30.14%，出院时死亡率达46.12%。单因素分析中，第7天死亡率与糖尿病史、心房颤动、正在进行抗凝治疗、需要气管插管和急诊科心肺复苏以及初始CT扫描存在脑室内出血和占位效应显著相关。死亡组的白细胞和粒细胞（但中性粒细胞与淋巴细胞比值及CRP无此情况）以及血糖显著更高。得出的炎症指标与死亡率终点无显著相关性。确定粒细胞临界值为9.6×10⁹/L、血糖临界值为132 mg/dl作为第7天死亡率预测指标。
sICH是一种可能导致高早期死亡率的严重疾病。急诊科即时检测生物标志物可能是一种易于获取且使用简便的预后工具。
